Provider Demographics
NPI:1316921554
Name:FRONCZAK, THOMAS (MSW LCSWR LICSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:FRONCZAK
Suffix:
Gender:M
Credentials:MSW LCSWR LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MAIN ST.
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6737
Mailing Address - Country:US
Mailing Address - Phone:401-431-2953
Mailing Address - Fax:
Practice Address - Street 1:5500 MAIN ST.
Practice Address - Street 2:SUITE 209
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6737
Practice Address - Country:US
Practice Address - Phone:401-431-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042315-11041C0700X
RIISW011441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
007057215Medicare ID - Type Unspecified